Kosmahl Markus, Pauser Ursula, Anlauf Martin, Klöppel Günter
Department of Pathology, University of Kiel, Germany.
Mod Pathol. 2005 Sep;18(9):1157-64. doi: 10.1038/modpathol.3800446.
Cystic tumors of the pancreas are uncommon but important because of their diverse pathology and biology. Their wide spectrum also includes cystic variants of otherwise solid tumors, such as cystic endocrine tumors, cystic acinar cell carcinomas and ductal adenocarcinomas with cystic changes. In this study, we screened pancreatic ductal adenocarcinomas and their variants for macrocystic changes and determined the nature of the cysts (neoplastic vs non-neoplastic). Of 483 tumors 38 (8%) had cystic features. The largest group consisted of 24 pancreatic ductal adenocarcinomas showing a large-gland pattern with small cysts whose diameter varied between 0.5 and 1.8 cm. The epithelial lining of these cysts was generally positive for CEA (83%) and/or MUC1 (71%) and MUC5AC (74%). p53 was positive in 57% of the cases. The second group of cystic tumors (8/483) showed degenerative cystic cavities with diameters ranging between 1 and 6 cm. This group consisted of poorly differentiated pancreatic ductal adenocarcinomas, undifferentiated carcinomas with or without osteoclast-like giant cells and one adenosquamous carcinoma. In the third group of cystic tumors there were four pancreatic ductal adenocarcinomas containing tumor-related retention cysts. Their epithelial cells were positive for MUC5AC, but negative for CEA, MUC1 and p53. The fourth group consisted of two pancreatic ductal adenocarcinomas showing closely attached pseudocysts caused by tumor-associated pancreatitis. The results indicate that a considerable number of pancreatic ductal adenocarcinomas and their variants display cystic features and must therefore be considered in the differential diagnosis of cystic neoplasms of the pancreas. Moreover, not all of the cystic structures we observed were neoplastic in nature. They may also represent non-neoplastic changes, such as retention cysts and inflammatory pseudocysts.
胰腺囊性肿瘤并不常见，但因其多样的病理和生物学特性而具有重要意义。其范围广泛，还包括其他实性肿瘤的囊性变体，如囊性内分泌肿瘤、囊性腺泡细胞癌以及伴有囊性改变的导管腺癌。在本研究中，我们筛查了胰腺导管腺癌及其变体是否存在大囊状改变，并确定囊肿的性质（肿瘤性与非肿瘤性）。在483个肿瘤中，38个（8%）具有囊性特征。最大的一组由24例胰腺导管腺癌组成，呈现大腺泡模式并伴有小囊肿，囊肿直径在0.5至1.8厘米之间。这些囊肿的上皮衬里通常CEA阳性（83%）和/或MUC1阳性（71%）以及MUC5AC阳性（74%）。p53在57%的病例中呈阳性。第二组囊性肿瘤（483例中的8例）表现为直径在1至6厘米之间的退行性囊腔。该组包括低分化胰腺导管腺癌、伴有或不伴有破骨细胞样巨细胞的未分化癌以及1例腺鳞癌。在第三组囊性肿瘤中有4例胰腺导管腺癌含有肿瘤相关潴留囊肿。其上皮细胞MUC5AC阳性，但CEA、MUC1和p53阴性。第四组由2例胰腺导管腺癌组成，显示由肿瘤相关性胰腺炎引起的紧密附着的假性囊肿。结果表明，相当数量的胰腺导管腺癌及其变体具有囊性特征，因此在胰腺囊性肿瘤的鉴别诊断中必须予以考虑。此外，我们观察到的并非所有囊性结构本质上都是肿瘤性的。它们也可能代表非肿瘤性改变，如潴留囊肿和炎性假性囊肿。
